Webb, George ' • NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
IGe This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District
(Town Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CER-
TIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No..•a 0
Town, Verge
Dist. No. -ate -.. Cou i,t4 ..„ of City
/ ,, ) (If city, give street address)
Name of deceased... w ' Veteran
(If veteran, give name of War)
H l Single, married, wider, /
/!�e. 19.6.
Sex .. or divorced (write—the word) ate of eath..�,
Age...- Y s Months D s Birthplace.. ../ ✓ 7. - `
Cause of-Death.- •
-
Certificate was signed •-4�!-i• •D'
Address.vim .. •., `
Place of Burial (or Removal)--- - - of) y..--
(If body is to be to poranly h d, fl co later)
Cemetery - •, .Date of Bwria ..•l.' 19.1�7.•
(if-body is to be temporarily hel , fill In space later)
The Certificate of Death containing the above stated particular having been presented to me, after careful exami-
nation,•the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accepted the same for registration, have recorded it in my Local Record with t above stated Registered
Numbe nd on the ba ' t eof I HE BY GRANT A PER IT -
to --
(7&---/-4,:37r
( e) ddress
the to hold temporarily and he body
(Undo alter or person having charge of corpse) (Inter;remove . er se dispose of [state how
Dated h7 i ;?— 1962- (Signed)--f-- -
al Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of bo to ny part of the State (subject to local
cemetery or other regulations), unless removal is by common carrier, in which case a T resit Permit (VS No. 62) is required.
Form VS. 61. (Rev, 6/63) (3A2-323)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date 2,74- 7' wgs 7 Ll (/r 19_ 7
(Interment )
(Name of Cemetery, Crematorium, etc.)
Section_ Lot No. Grave No.
(Signed)
ktt�2C
. 1 —
(PersonZ in Charge) 2
Address ` l C"t
Person in charge must retirn this Permit to the Regis ar
of his District within SEVEN (7) DAYS from above date. If no
person is in charge, the FUNERAL DIRECTOR or UNDER-
TAKER MUST SIGN ABOVE STATEMENT, write across the
face of the Permit the words "No person in charge," and FILE
PERMIT WITHIN THREE (3) DAYS with the Registrar of Dis-
trict in which cemetery is located.
SEXTONS,FUNERAL DIRECTORS and UNDERTAKERS
violating the law relative to the return of permits are liable to
a penalty of NOT LESS THAN FIVE DOLLARS NOR MORE
THAN FIFTY DOLLARS FOR THE FIRST OFFENSE.The law
will be enforced. Local Registrars are required, under penalty,
to report violations thereof.